| NPI | 1902947757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 343220-1204) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TN 2491) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2023-08-08 |